It is one of the first practical questions patients ask — and a fair one. Before committing to any treatment, you want to know what is involved, how long it takes, and what to expect at each stage.
The honest answer is that the number of shockwave therapy sessions you need depends on the condition being treated, its severity, and your individual clinical response. There is no universal number that applies to every patient and every condition. What I can give you is the clinical evidence behind the protocols we use at Shockwave ReVibe Clinic — and a clear explanation of why those numbers are what they are. For an introduction to the treatment itself, see our complete guide to shockwave therapy in London.
"What the session numbers in published clinical trials represent is the protocol that produced the best outcomes across the largest number of patients — not arbitrary numbers."
Why Session Numbers Vary by Condition
Shockwave therapy works by triggering biological regeneration processes in the target tissue — angiogenesis (new blood vessel formation), collagen synthesis, anti-inflammatory effects, and pain modulation. These processes take time to initiate and consolidate. The number of sessions required reflects how much biological stimulus the tissue needs to produce a durable therapeutic response.
Conditions involving deep tissue — the penile arteries in ED, the prostate in CPPS — require more sessions than superficial conditions. Chronic conditions with significant tissue degeneration require more sessions than acute or mild presentations. Individual response varies — some patients achieve significant improvement in fewer sessions; others need the full course.
At Shockwave ReVibe Clinic, we follow evidence-based protocols derived directly from the published literature — not arbitrary numbers.
Session Numbers by Condition
Erectile Dysfunction — 6 to 12 Sessions
For vasculogenic ED, the standard protocol is 6-12 sessions depending on clinical need, delivered weekly or bi-weekly. This protocol is derived from the clinical trials that form the evidence base for shockwave therapy in ED — including the 2017 meta-analysis of 14 randomised controlled trials involving 833 patients, which demonstrated significant improvement in erectile function scores following Li-ESWT. (Lu Z et al., International Journal of Impotence Research, 2017)
Each session delivers focused acoustic energy to the corpus cavernosum, the penile arteries, and the crural (base) region of the penis — the anatomical targets for vascular ED treatment. Sessions last approximately 20-25 minutes.
Most patients begin to notice improvement after the third or fourth session. The full biological regeneration process — as new blood vessels form and endothelial repair consolidates — typically develops over 6-12 weeks following the final session. Men with more severe vasculogenic ED may require up to 12 sessions to achieve optimal regeneration of penile tissue and arterial function. Read more in our guide to ED causes.
Chronic Pelvic Pain Syndrome (CPPS) — 6 to 8 Sessions
For CPPS, the protocol is 6-8 sessions, delivered weekly or bi-weekly, with each session lasting approximately 20-25 minutes.
The variation between 6 and 8 sessions reflects symptom severity as assessed by the NIH-CPSI (Chronic Prostatitis Symptom Index) at baseline. Men with higher baseline scores — more severe pain across the pain, urinary, and quality of life domains — typically complete 8 sessions. Milder presentations are often adequately treated in 6.
The landmark 2018 RCT by Zimmermann et al., which demonstrated 78% improvement in NIH-CPSI scores following focal shockwave therapy, used a 6-session protocol. (Zimmermann R et al., European Urology, 2018) We reassess NIH-CPSI scores during the treatment course to track progress and adjust the protocol if clinically indicated. See our full guide to shockwave therapy for CPPS, or our prostatitis treatment service.
Plantar Fasciitis — 3 to 5 Sessions
For chronic plantar fasciitis, the protocol is 3-5 sessions, delivered weekly, each lasting 15-20 minutes.
Plantar fasciitis — being a more superficial condition than ED or CPPS — responds to a shorter treatment course. The NICE-recommended protocol for refractory plantar fasciitis (symptoms persisting beyond 3 months of conservative management) supports 3 sessions as the minimum adequate course, with extension to 5 sessions for chronic or calcific presentations. (NICE IPG311, 2009)
Most patients notice meaningful improvement after the second or third session. The full benefit — as new collagen synthesis and neovascularisation consolidate — develops over 6-12 weeks following the final session.
Frozen Shoulder — 3 to 6 Sessions
For adhesive capsulitis (frozen shoulder), the protocol is 3-6 sessions depending on the stage of the condition and severity of symptoms.
Early-stage frozen shoulder (freezing phase, significant pain) typically responds well to 3-4 sessions. Established frozen shoulder (frozen phase, restricted movement) may benefit from a longer course of up to 6 sessions, often combined with a structured physiotherapy programme.
Calcific Shoulder Tendinopathy — 3 to 5 Sessions
Where calcium deposits are present in the rotator cuff tendons, 3-5 sessions of focal shockwave therapy are typically required to achieve meaningful calcification resorption and symptom relief, as part of our musculoskeletal pain therapy. The size and density of the calcification influences the number of sessions needed — larger deposits may require the full 5-session course.
Achilles Tendinopathy and Other Tendinopathies — 3 to 5 Sessions
Chronic tendinopathies — Achilles, patellar, hamstring — typically respond to 3-5 sessions of focal shockwave therapy, delivered weekly alongside an eccentric loading programme, as part of our sports injury treatment. Shockwave therapy combined with eccentric exercise is now considered a first-line treatment for mid-portion Achilles tendinopathy in patients who have not responded to physiotherapy alone.
Peyronie's Disease — 6 Sessions (Active Phase)
For Peyronie's disease in the active phase, the protocol is 6 sessions, delivered bi-weekly.
Shockwave therapy in Peyronie's targets the fibrous plaques causing penile curvature and the associated erectile dysfunction. Treatment is most effective in the active phase (first 12-18 months of symptom onset) — when the plaques are still remodelling — rather than the stable phase when calcification is established.
Session Numbers at a Glance
| Condition | Sessions | Session Duration | Frequency |
|---|---|---|---|
| Erectile Dysfunction | 6-12 | 20-25 minutes | Weekly or bi-weekly |
| CPPS / Chronic Prostatitis | 6-8 | 20-25 minutes | Weekly or bi-weekly |
| Plantar Fasciitis | 3-5 | 15-20 minutes | Weekly |
| Frozen Shoulder | 3-6 | 20-30 minutes | Weekly |
| Calcific Shoulder Tendinopathy | 3-5 | 20-25 minutes | Weekly |
| Achilles Tendinopathy | 3-5 | 20-25 minutes | Weekly |
| Peyronie's Disease | 6 | 15-20 minutes | Bi-weekly |
What Happens Between Sessions
A question I am frequently asked is whether patients need to rest or restrict activity between shockwave therapy sessions.
The answer varies slightly by condition, but the general principle is that shockwave therapy requires no significant downtime. Most patients return to normal activity immediately after each session. Some mild tenderness at the treatment site for 24-48 hours following the first session is normal and resolves without intervention.
For musculoskeletal conditions — plantar fasciitis, Achilles tendinopathy, frozen shoulder — avoiding high-impact activity for 48 hours after each session is sensible. The physiological rationale is that the acute inflammatory response triggered by shockwave therapy is part of the healing process — blunting it with anti-inflammatory medication or excessive loading immediately after treatment is counterproductive.
For ED and CPPS — no activity restriction is required between sessions.
When Will You See Results?
This is the question that matters most to patients — and the honest answer is that shockwave therapy is not a treatment whose results are immediate.
The biological processes it initiates — new blood vessel formation, collagen synthesis, tissue remodelling — take weeks to complete. The timeline for results varies by condition:
- During the treatment course — most patients notice some improvement, reduced pain, improved function, by the second or third session. This is partly due to the direct analgesic effect of shockwave therapy and partly the beginning of the biological regeneration response.
- 4-6 weeks after completion — the biological regeneration process is consolidating. Most patients see the clearest improvement in this window.
- 6-12 weeks after completion — full results. Clinical trials consistently use 12-week post-treatment assessment as the primary endpoint, because this is when the biological regeneration has fully developed.
- At 12 months — published trials for shockwave therapy in ED, CPPS, and plantar fasciitis consistently show maintained improvement at 12-month follow-up, confirming that the results are durable, not temporary.
Dr Kishore Bahl
Every treatment protocol at Shockwave ReVibe Clinic is set and reassessed personally by Dr Bahl — not a fixed package. Why this matters clinically →
Frequently Asked Questions
Can I have fewer sessions than recommended?
The protocols are based on the minimum number of sessions that produced clinically significant improvement in published trials. Fewer sessions may produce partial improvement — but the full course gives the best probability of the sustained response documented in the evidence base. Dr Bahl reassesses progress during treatment and will advise if fewer sessions are clinically appropriate for your specific response.
What if I don't respond after the full course?
A minority of patients do not respond significantly to the initial treatment course. At 12-week follow-up, Dr Bahl reassesses using validated scoring tools. Where response has been partial, a second course is discussed. Where there has been no meaningful response, alternative or adjunctive treatments are considered.
Can sessions be spread out over longer intervals?
Weekly or bi-weekly delivery is recommended based on the clinical trial protocols. Longer intervals between sessions may reduce the cumulative biological regeneration stimulus. If scheduling constraints require some flexibility, this is discussed at consultation.
Is there a maximum number of sessions?
No absolute maximum exists, but the protocols are designed to deliver the optimal therapeutic stimulus — more sessions beyond the recommended course do not necessarily produce additional benefit and are not standard practice.
Do I need a GP referral to start treatment?
No. At Shockwave ReVibe Clinic you can book directly without a GP referral. Initial consultation: £59.
Clinical References
- Lu Z et al. (2017). Low-intensity extracorporeal shock wave treatment improves erectile dysfunction. International Journal of Impotence Research, 29(3): 95-99.
- Gruenwald I et al. (2014). Shockwave treatment of erectile dysfunction. Therapeutic Advances in Urology, 5(2): 95-99.
- Zimmermann R et al. (2018). Extracorporeal shock wave therapy for chronic pelvic pain syndrome. European Urology, 73(1): 74-81.
- National Institute for Health and Care Excellence (2009). Extracorporeal shockwave therapy for refractory plantar fasciitis. NICE IPG311.
- Rompe JD et al. (2010). Shock wave therapy for chronic plantar fasciopathy. British Journal of Sports Medicine, 44(2): 109-111.
Dr Kishore Bahl is a Specialist Grade Doctor in Urology (GMC Registration: 6070860) and founder of Shockwave ReVibe Clinic, 22 Notting Hill Gate, London W11 3JE. To book a consultation, call 020 3004 0564 or visit shockwave-revibe.co.uk.
Last reviewed: August 2026